Provider Demographics
NPI:1154598951
Name:DEVISETTY, LAXMI VASUDHA (MD)
Entity type:Individual
Prefix:
First Name:LAXMI
Middle Name:VASUDHA
Last Name:DEVISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ST LUKES BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5665
Mailing Address - Country:US
Mailing Address - Phone:484-658-9330
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCESS RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:609-896-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87151207W00000X
MI4301100487207W00000X
PAMD439537207W00000X
NJ25MA12073000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology